Provider Demographics
NPI:1184110595
Name:CROWE, REGGIE DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:REGGIE
Middle Name:DOUGLAS
Last Name:CROWE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-0566
Mailing Address - Country:US
Mailing Address - Phone:309-846-3330
Mailing Address - Fax:
Practice Address - Street 1:39648 RESERVATION HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MN
Practice Address - Zip Code:56270-1302
Practice Address - Country:US
Practice Address - Phone:507-697-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist